Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFL.
Division of Infectious DiseasesDepartment of Medicine and Center for Clinical Epidemiology and BiostatisticsDepartment of Biostatistics, Epidemiology, and InformaticsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA.
Hepatology. 2021 Aug;74(2):566-581. doi: 10.1002/hep.31732. Epub 2021 Jul 1.
Our aim was to evaluate the impact of direct-acting antivirals (DAAs) on decompensated cirrhosis (DCC) and HCC in patients with chronic HCV and substance use disorder (SUD) compared with those without an SUD.
This retrospective cohort study used the MarketScan database (2013-2018) to identify 29,228 patients with chronic HCV, where 22% (n = 6,385) had ≥1 SUD diagnosis. The inverse probability of treatment weighted multivariable Cox proportional hazard models were used to compare the risk of developing DCC and HCC. Among the those who were noncirrhotic, treatment reduced the DCC risk among SUD (adjusted hazard ratio [aHR] 0.13; 95% CI, 0.06-0.30) and non-SUD (aHR 0.11; 95% CI, 0.07-0.18), whereas the risk for HCC was not reduced for the SUD group (aHR 0.91; 95% CI, 0.33-2.48). For those with cirrhosis, compared with patients who were untreated, treatment reduced the HCC risk among SUD (aHR, 0.33; 95% CI, 0.13-0.88) and non-SUD (aHR, 0.40; 95% CI, 0.25-0.65), whereas the risk for DCC was not reduced for the SUD group (aHR, 0.64; 95% CI, 0.37-1.13). Among patients with cirrhosis who were untreated, the SUD group had a higher risk of DCC (aHR, 1.52; 95% CI, 1.03-2.24) and HCC (aHR, 1.69; 95% CI, 1.05-2.72) compared with non-SUD group.
Among the HCV SUD group, DAA treatment reduced the risk of DCC but not HCC for those who were noncirrhotic, whereas DAA treatment reduced the risk of HCC but not DCC for those with cirrhosis. Among the nontreated, patients with an SUD had a significantly higher risk of DCC and HCC compared with those without an SUD. Thus, DAA treatment should be considered for all patients with HCV and an SUD while also addressing the SUD.
本研究旨在评估直接作用抗病毒药物（DAAs）对伴有和不伴有物质使用障碍（SUD）的慢性丙型肝炎病毒（HCV）患者失代偿期肝硬化（DCC）和肝细胞癌（HCC）的影响。
本回顾性队列研究使用 MarketScan 数据库（2013-2018 年），共纳入 29228 例慢性 HCV 患者，其中 22%（n=6385）有≥1 次 SUD 诊断。采用逆概率治疗加权多变量 Cox 比例风险模型比较了 DCC 和 HCC 的发病风险。在非肝硬化患者中，SUD 组（校正风险比[aHR]0.13；95%置信区间[CI]，0.06-0.30）和非 SUD 组（aHR 0.11；95%CI，0.07-0.18）接受治疗降低了 DCC 风险，但 SUD 组 HCC 风险未降低（aHR 0.91；95%CI，0.33-2.48）。对于肝硬化患者，与未治疗患者相比，SUD 组（aHR，0.33；95%CI，0.13-0.88）和非 SUD 组（aHR，0.40；95%CI，0.25-0.65）接受治疗降低了 HCC 风险，但 SUD 组 DCC 风险未降低（aHR，0.64；95%CI，0.37-1.13）。在未治疗的肝硬化患者中，SUD 组 DCC（aHR，1.52；95%CI，1.03-2.24）和 HCC（aHR，1.69；95%CI，1.05-2.72）的发病风险均高于非 SUD 组。
在 HCV SUD 组中，对于非肝硬化患者，DAA 治疗降低了 DCC 风险，但不降低 HCC 风险，而对于肝硬化患者，DAA 治疗降低了 HCC 风险，但不降低 DCC 风险。在未治疗的患者中，与无 SUD 患者相比，有 SUD 的患者 DCC 和 HCC 的发病风险显著更高。因此，对于所有伴有 SUD 的 HCV 患者，均应考虑进行 DAA 治疗，同时还应解决 SUD 问题。
